Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Department of General Surgery, St. Elisabeth’s Hospital, Graz, Austria
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A short history of vitamin D in critical care Only 10 years ago, a potential link between acute illness and vitamin D, which is well known for its role in calcium and bone homeostasis, was regarded as quite absurd – how could this hormone be
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Parameswaran GI Sethi S & Thanavala Y . T-regulatory cells and programmed death 1+ T cells contribute to effector T-cell dysfunction in patients with chronic obstructive pulmonary disease . American Journal of Respiratory and Critical Care Medicine
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Objective
Following the evolution of COVID-19 pandemic, reports pointed on a high prevalence of thyroiditis-related thyrotoxicosis. Interpretation of thyroid tests during illness, however, is hampered by changes occurring in the context of non-thyroidal illness syndrome (NTIS). In order to elucidate these findings, we studied thyroid function in carefully selected cohorts of COVID-19 positive and negative patients.
Design
Cohort observational study.
Methods
We measured TSH, FT4, T3 within 24 h of admission in 196 patients without thyroid disease and/or confounding medications. In this study, 102 patients were SARS-CoV-2 positive; 41 admitted in the ICU, 46 in the ward and 15 outpatients. Controls consisted of 94 SARS-CoV-2 negative patients; 39 in the ICU and 55 in the ward. We designated the thyroid hormone patterns as consistent with NTIS, thyrotoxicosis and hypothyroidism.
Results
A NTIS pattern was encountered in 60% of ICU and 36% of ward patients, with similar frequencies between SARS-CoV-2 positive and negative patients (46.0% vs 46.8%, P = NS). A thyrotoxicosis pattern was observed in 14.6% SARS-CoV-2 ICU patients vs 7.7% in ICU negative (P = NS) and, overall in 8.8% of SARS-CoV-2 positive vs 7.4% of negative patients. In these patients, thyroglobulin levels were similar to those with normal thyroid function or NTIS. The hypothyroidism pattern was rare.
Conclusions
NTIS pattern is common and relates to the severity of disease rather than SARS-CoV-2 infection. A thyrotoxicosis pattern is less frequently observed with similar frequency between patients with and without COVID-19. It is suggested that thyroid hormone monitoring in COVID-19 should not differ from other critically ill patients.
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Objective
We evaluated the diagnostic accuracy of perinodular stiffness, four risk stratification systems (RSSs) (KWAK-TIRADS, ACR-TIRADS, EU-TIRADS, and C-TIRADS), and the combination of perinodular stiffness and the four RSSs in differentiating malignant from benign thyroid nodules (TNs).
Methods
A total of 788 TNs in 726 patients were examined with conventional ultrasound (US) examination and sound touch elastography (STE). All TNs were classified by each of the four RSSs. The stiffness inside (E) the TNs was measured by STE. The stiffness of the 2.0-mm perinodular region (Eshell) was measured with the Shell measurement function of STE. The diagnostic performances of four RSSs, the E values, and the Eshell values were evaluated. All TNs were further divided into subgroups based on size (≤ 10 mm group and > 10 mm group).
Results
Ninety-six TNs were classified as benign and 692 as malignant. Among the single-method approaches, ACR-TIRADS showed the highest AUC (0.77) for differentiating malignant from benign TNs for all TNs included. Eshell showed the highest AUC (0.75) in differentiating malignant from benign TNs for TNs with sizes ≤ 10 mm, and there were no significant differences in AUC among all single methods for diagnosis of TNs with sizes > 10 mm (P > 0.05). The combination of C-TIRADS and Eshell/E yielded the highest AUC for all TNs (0.83) and for TNs with size ≤ 10 mm (0.85) compared with other combinations.
Conclusions
Eshell/E combined with conventional US improves the diagnostic accuracy in TNs and may reduce unnecessary fine-needle aspiration.
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EA 7426 Hospices Civils de Lyon-University Claude Bernard Lyon 1-Biomérieux ‘Pathophysiology of Injury-Induced Immunosuppression’ Pi3, Lyon, France
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Only few descriptions of intraoperative carcinoid syndrome (ioCS) have been reported. The primary objective of this study was to describe ioCS. A second aim was to identify risk factors of ioCS. We retrospectively analysed patients operated for small-bowel neuroendocrine tumour in our institution between 2007 and 2015, and receiving our preventive local regimen of octreotide continuous administration. ioCS was defined as highly probable in case of rapid (<5 min) arterial blood pressure changes ≥40%, not explained by surgical/anaesthetic management and regressive ≥20% after octreotide bolus injection. Probable cases were ioCS which did not meet all criteria of highly-probable ioCS. Suspected ioCS were detected on the anaesthesia record by an injection of octreotide due to a manifestation which did not meet the criteria for highly-probable or probable ioCS. A total of 81 patients (liver metastases: 59, prior carcinoid syndrome: 49, carcinoid heart disease: 7) were included; 139 ioCS occurred in 45 patients: 45 highly probable, 67 probable and 27 suspected. ioCs was hypertensive (91%) and/or hypotensive (29%). There was no factor, including the use of vasopressors, significantly associated with the occurrence of an ioCS. All surgeries were completed and one patient died from cardiac failure 4 days after surgery. After preoperative octreotide continuous infusion, ioCS were mainly hypertensive. No ioCS risk factors, including vasopressor use, were identified. No intraoperative carcinoid crisis occurred, suggesting the clinical relevance of a standardized octreotide prophylaxis protocol.
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enhanced by the provided critical care, recovery does not always follow fluently. When patients outlive the acute phase of critical illness but remain dependent on vital organ support, sometimes for multiple weeks, the central activation of most
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Service of Endocrinology, Laboratory of Intensive Care, Department of Microbiology and Molecular Medicine, Diabetes, Hypertension and Nutrition
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Service of Endocrinology, Laboratory of Intensive Care, Department of Microbiology and Molecular Medicine, Diabetes, Hypertension and Nutrition
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Service of Endocrinology, Laboratory of Intensive Care, Department of Microbiology and Molecular Medicine, Diabetes, Hypertension and Nutrition
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Sprung CL Codish S Klein M Einav S Bar-Lavie Y Singer PP Nimrod A Sachs J . Temporal trends in patient characteristics and survival of intensive care admissions with sepsis: a multicenter analysis* . Critical Care Medicine 2012
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combinations of the keywords and text words: (ICU OR intensive care unit OR intensive care OR critical care OR critical illness OR postoperative care OR cardiac care facility* OR coronary care OR recovery room OR burn unit OR critically ill OR cardiac care OR
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reasonable request. References 1 Teblick A Vander Perre S Pauwels L Derde S Van Oudenhove T Langouche L & Van den Berghe G . The role of pro-opiomelanocortin in the ACTH-cortisol dissociation of sepsis . Critical Care 2021 25 65
Faculty of Medicine, University of Basel, Basel, Switzerland
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Faculty of Medicine, University of Basel, Basel, Switzerland
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Faculty of Medicine, University of Basel, Basel, Switzerland
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Faculty of Medicine, University of Basel, Basel, Switzerland
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Kutz A Conca A Reutlinger B Canavaggio P Biomarkers from distinct biological pathways improve early risk stratification in medical emergency patients: the multinational, prospective, observational TRIAGE study . Critical Care 2015 19 377
